JP2014514012A - Surgical instrument with multi-speed direction switching mechanism - Google Patents

Abstract

  A launch configured to generate a remotely controllable user interface and a rotational firing motion on a first activation of the remote controllable user interface and a rotational retract motion on another actuation of the remote controllable user interface A surgical instrument having a drive. The instrument includes a first drive member that is selectively engageable with a remotely controllable user interface and a second drive member that is selectively engageable with a remotely controllable user interface. . The instrument also includes an elongate shaft assembly operably engaged with the first drive member and the second drive member. The instrument further includes an end effector coupled to the elongate shaft assembly. The end effector includes an elongate channel configured to operably support a staple cartridge therein and an anvil movably coupled to the elongate channel. The end effector also includes a cutting member operably supported within the elongate channel that is operatively engaged with the elongate shaft assembly. The instrument is configured such that when the remotely controllable user interface operates the first drive member, the first actuation advances the cutting member by a first distance and the remotely controllable user interface is the second drive member. When actuating, the other action is to retract the cutting member by a second distance and the second distance is an instrument that is greater than the first distance.

Description

(Cross-reference of related applications)
This application is a continuation-in-part application claiming the benefit of US Patent No. 11 / 810,015 filed June 6, 2007, titled “Surgical Instrument Have a Multiple Rate Directional Switching Mechanical”. This application is related to the following commonly owned US patent applications filed concurrently with this specification, which are hereby incorporated by reference in their entirety.
(1) US Patent No. 7,832,408, US Patent Application No. 11 / 810,016 issued on November 16, 2010 as Attorney Docket No. 070058 / END6088USNP, titled “SURGICAL INSTRUMENT HAVING A DIRECTIONAL SWITCHING MECHANISM” And (2) U.S. Patent No. 7,819,299, U.S. Patent Application No. 11 / 809,935 issued on October 26, 2010 as Attorney Docket No. 070060 / END6090USNP, entitled "SURGICAL INSTRUMENT HAVING A" COMMON TRIGGER FOR ACTUATING AN END EFFECTOR CLOSEING SYSTEM AND A STAFF FIRING SYSTEM ".

(Field of Invention)
The present invention relates generally to surgical stapling instruments, and more particularly to a surgical stapler having an end effector closure system and a firing system for deploying staples.

  As is known in the art, surgical staplers often deploy staples in soft tissue to reduce bleeding from the soft tissue, for example, particularly when the tissue is transected, or Used to remove. For example, surgical staplers, such as end cutters, often include an end effector configured to secure soft tissue between a first jaw member and a second jaw member. The first jaw member often includes a staple cartridge configured to removably store staples therein, and the second jaw member often includes an anvil. In use, staples are typically deployed from the staple cartridge by a drive that traverses the channels in the staple cartridge, deforms the staple relative to the anvil, and secures the soft tissue layer together. In many cases, as is known in the art, staples are deployed in several staple lines or rows to more accurately secure tissue layers together. The end effector may also include a cutting member, such as a knife, that advances between two rows of staples to cut the soft tissue after the layers of soft tissue have been stapled together.

  After the drive and cutting member have advanced in the end effector, it is often necessary to retract the drive and / or cutting member to their starting position. Previous surgical staplers include a return spring that retracts the cutting member relative to the staple cartridge after the surgical stapler release button or toggle switch has been actuated by the surgeon. However, such a stapler cannot partially retract the cutting member so that the cutting member must be fully retracted before the cutting member can be re-advanced. Other previous surgical staplers include a plurality of triggers that are operatively engaged with a system for closing the jaw members and advancing and / or retracting the drive and cutting members. Such devices are suitable for their original purpose, but often provide the surgeon with a trigger that is operatively engaged with the closure system and for advancing the staple driver and cutting member. Requires the hand to change position to grip different triggers operably engaged with the system. Previous surgical staplers were developed to have a single trigger for both closing the jaw members and advancing the drive and cutting members, but such devices are both in the initial actuation of the trigger. Perform the function. Although preferred under certain circumstances, a device that performs both functions with the same trigger actuation is often very difficult to operate because a strong force is required to actuate the trigger. is there. In addition, such a device closes the jaw members and deploys the staples in the same triggering action, so that the position of the closed jaw members is evaluated before the staples are deployed in soft tissue, Does not provide the surgeon with the opportunity to reposition. There is a need for improvements to the above.

The above and other features and advantages of various embodiments of the present invention, and the manner in which they are obtained, will become more apparent from the following description of embodiments of the invention taken in conjunction with the accompanying drawings and The invention itself is better understood.
1 is a perspective view of a surgical instrument according to an embodiment of the present invention. FIG. 2 is an exploded view of the shaft portion and end effector of the surgical instrument of FIG. 1. FIG. 2 is an exploded view of the handle portion of the surgical instrument of FIG. 1. FIG. 4 is a partial side view of the handle portion of FIG. 3 with some components of the surgical instrument removed. FIG. 4 is a top view of the handle portion of FIG. 3 illustrating the surgical instrument configured to advance a cutting member in the end effector with some components of the surgical instrument removed. FIG. 4 is a bottom view of the handle portion of FIG. 3 illustrating the surgical instrument configured to advance a cutting member in the end effector with some components of the surgical instrument removed. FIG. 4 is a partial perspective view of the handle portion of FIG. 3 with some components of the surgical instrument removed. FIG. 2 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument during a first actuation of the trigger. FIG. 9 is a partial perspective view of the surgical instrument of FIG. 1 configured as illustrated in FIG. 8 with some components of the surgical instrument removed. FIG. 2 is a perspective view of a cam of the end effector closure system of the surgical instrument of FIG. 1. FIG. 11 is a front view of the cam of FIG. 10 illustrating various relative positions of the lock of the anvil closure system. FIG. 2 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument after the trigger is released after the first actuation of the trigger. FIG. 3 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument during a second actuation of the trigger. FIG. 14 is a partial perspective view of the surgical instrument of FIG. 1 configured as illustrated in FIG. FIG. 3 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument during a third actuation of the trigger. FIG. 3 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument during a fourth actuation of the trigger. FIG. 2 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument after the trigger is released after the fourth actuation of the trigger and the surgical instrument switching mechanism is activated. FIG. 9 is a perspective view of the surgical instrument of FIG. 1 illustrating the configuration of the surgical instrument upon a seventh actuation of the trigger with the cutting member fully retracted. FIG. 19 is a partial front view of the surgical instrument of FIG. 1 illustrated with the configuration of FIG. 18 with the surgical instrument components removed. FIG. 9 is a partial perspective view of the housing of the surgical instrument of FIG. 1 illustrating the interaction of the firing drive and the housing after a seventh actuation of the trigger. FIG. 7 is a perspective view of a gear reduction mechanism for a surgical instrument with a portion of an exploded gear reduction housing according to an alternative embodiment of the present invention. The exploded view of the gear reduction mechanism of FIG. FIG. 6 is a perspective view of a surgical instrument according to an alternative embodiment of the present invention. FIG. 24 is an exploded view of the end effector and shaft assembly of the surgical instrument of FIG. FIG. 24 is an exploded view of the handle portion of the surgical instrument of FIG. FIG. 24 is an exploded view of the surgical instrument of FIG. 23 with the surgical instrument components removed. FIG. 24 is a perspective view of the surgical instrument of FIG. 23 with the surgical instrument components removed. FIG. 24 is a second perspective view of the surgical instrument of FIG. 23 with the surgical instrument component removed. FIG. 24 is a side view of the surgical instrument of FIG. 23 configured to advance a cutting member within an end effector. FIG. 24 is a side view of the surgical instrument of FIG. 23 configured to retract a cutting member within an end effector. FIG. 6 is a perspective view of a direction switching mechanism according to an alternative embodiment of the present invention, with some components disassembled and other components illustrated in cross-section. FIG. 32 is a plan view of the direction switching mechanism of FIG. 31 with some components removed and other components illustrated in cross-section. FIG. 4 is a diagram of a bistable adaptation mechanism according to an alternative embodiment of the present invention.

  Corresponding reference characters indicate corresponding parts throughout the several views. The illustrations described herein illustrate preferred embodiments of the specification in one form and such illustration should not be construed as limiting the scope of the invention in any way.

  Certain exemplary embodiments are described below to provide an overall understanding of the principles of structure, function, manufacture, and use of the apparatus and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. The devices and methods described in detail herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments, and the scope of the various embodiments of the present invention is defined by the claims. It will be understood by those skilled in the art that only be defined. Features illustrated or described in connection with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.

  In various embodiments, a surgical instrument according to the present invention can include, for example, a system for inserting surgical staples into soft tissue. In at least one embodiment, the surgical instrument may include a staple cartridge configured to removably store staples therein and an anvil deployed from the staple cartridge for deforming the staples. For deploying the staples, the surgical instrument may include a staple drive configured to traverse the staple cartridge and a firing drive for advancing the staple drive within the staple cartridge. In various embodiments, the firing drive may include a drive bar that is translated in a substantially linear direction by a trigger operably engaged with the firing drive. In other embodiments, the firing drive may include a drive shaft that is rotated by a trigger. In such embodiments, the surgical instrument can include a shaft assembly that can convert the rotational motion of the drive shaft into a linear motion and translate the staple drive within the staple cartridge. Although the exemplary embodiment illustrated in FIGS. 1-20 and described below includes a firing drive having a rotational drive shaft, the present invention is not so limited. In addition, a general description of a firing drive having a rotary drive shaft is provided below, but other such devices are filed on June 27, 2006, and are co-pending US patent applications filed on June 27, 2006. 11 / 475,412, entitled MANUALLY DRIVER SURGICAL CUTTING AND FASTENING INSTRUMENT, the entire disclosure of which is incorporated herein by reference.

  With reference to FIG. 1, the surgical instrument 50 may include a handle portion 52, a trigger 54, an elongate shaft assembly 56, and an end effector 58. In various embodiments, the end effector 58 can include an anvil 62 and a staple cartridge channel 64, the channel 64 can be configured to receive the staple cartridge 66, and the anvil 62 can be pivotally connected to the channel 64. In at least one embodiment, at least one of the anvil 62 and the channel 64 is operable on the trigger 54 such that upon actuation of the trigger 54, the anvil 62 can be rotated into the closed position illustrated in FIG. Can be connected. In various embodiments, referring to FIGS. 2-4, the trigger 54 is configured to translate both the anvil 62 and the channel 64 relative to the outer sheath 57 of the elongate shaft assembly 56, and It can be operably engaged. Referring primarily to FIG. 4, the closure drive is operable with the trigger 54 such that a first actuation of the trigger 54 can rotate the cam 68 about the pin 70 and drive the closure link 72 in a substantially linear direction. An engaged cam 68 may be included. More specifically, the trigger 54 extends from the trigger 54 and can be configured to contact the cam 68 and the surface 71 of the lift cam 68 and move to the position illustrated in FIG. 8 (FIG. 3). ). The cam 68 may further include a cam slot 69, when the cam 68 is rotated from the position illustrated in FIG. 4 to the position illustrated in FIG. In this embodiment, the sliding closure link 72 can be engaged in the direction illustrated by arrow A (FIG. 4).

  With reference to FIGS. 2 and 4, the surgical instrument 50 may further include an appendage assembly within the elongate shaft assembly 56 (FIG. 1), the appendage assembly comprising a proximal channel portion 78, a distal channel portion 80, and , May be included. In various embodiments, channel portions 78 and 80 can be interconnected by cooperative engagement of protrusions or tongs 84 and grooves 86. More specifically, referring to FIG. 2, the proximal channel portion 78 may be assembled to the distal channel portion 80 such that the protrusion 84 is secured within the groove 86 in various embodiments. Half 77 and second half 79 may be included. In at least one embodiment, the proximal channel portion halves 77 and 79 are configured to provide a snap fit or press fit engagement between the proximal channel portion halves 77 and 79. An opening 83 may be included. In various other embodiments, channel portions 78 and 80 can be interconnected by any suitable means, and in at least one embodiment, although not illustrated, portions 78 and 80 can be integrally formed. Similar to the above, referring to FIG. 2, distal channel portion 80 may include a distal end 88 that may be connected to staple cartridge channel 64. More specifically, the distal channel portion 80 and the staple cartridge channel 64 can cooperate using any suitable interconnect therebetween, but can provide, for example, a press-fit or snap-fit interconnect therebetween. Tongs and groove functions can be included.

  Referring to FIG. 4, the proximal end 82 of the channel portion 78 is moved by the pin 53 so that when the closure link 72 is translated by the cam 68, the channel portion 78 is translated within the elongate shaft assembly 56. It can be connected to the closing link 72. In at least one embodiment, channel portion 78 extends from channel portion 78 and slides within recess 85 (FIG. 3) in housing portion 90 to substantially limit translation of channel portion 78 along the axis. It may further include a protrusion 87 that may be configured to. When the staple cartridge channel 64 is connected to the proximal channel portion 78 via the distal channel portion 80, the anvil 62 pivotally connected to the channel 64 and the channel 64 causes the cam 68 to trigger 54 as described above. Can be moved in direction A when rotated by. In at least one embodiment, referring to FIG. 2, the proximal end 63 of the anvil 62 is adjacent to the outer sheath 57 of the elongate shaft assembly 56 when the channel 64 and the anvil 62 are translated relative to the sheath 57. Can be configured as follows. After the proximal end 63 of the anvil 62 contacts the outer sheath 57, the anvil 62 is configured to rotate toward the channel 64 and the staple cartridge 66 to close the anvil 62, as illustrated in FIG. Can be done. In various embodiments, referring to FIG. 2, the channel 64 may include a slot 65 that may be configured to guide the anvil 62 when bearing pivoted relative to the channel 64. Once the anvil 62 is closed, the surgical instrument may further include a lock that holds the anvil 62 in the closed position. In various embodiments, referring to FIGS. 9-11, the surgical instrument 50 may include a spring lock 92 that is mounted to the housing 90, which includes an anvil 62 that is further detailed below by the surgeon. As a result, the cam 68 can be configured to be removably retained, holding the closure link 72, the channel portions 78 and 80, the channel 64, and the anvil 62 in place until it is desired to open.

  In various embodiments, after the anvil 62 is placed in its closed position, the trigger 54 can be reactivated to operate a firing drive that advances the cutting member 96 within the end effector 58. In at least one embodiment, the firing drive can be disengaged from the trigger 54 prior to the first actuation of the trigger 54. In such embodiments, the first actuation of the trigger 54 operatively engages the trigger 54 with the firing drive such that the firing drive is in operative engagement with the trigger 54, and The components of the firing drive may be released. In the illustrated embodiment, referring to FIGS. 3 and 4, the firing drive includes a trigger gear portion 100 extending from the trigger 54, a gear train 102, and a gear platform 130, as will be described in further detail below. And a rotatable drive shaft 106 that may be configured to advance the cutting member 96 within the end effector 58. As illustrated in FIGS. 3-7, the gear train 102 may include a ratchet gear 108, a main drive gear 110, a bevel drive gear 112, and a bevel gear 114, prior to the first actuation of the trigger 54. The cam 68 may be configured to engage and disengage from the main drive gear 110 and bias the ratchet gear 108. More specifically, referring to FIG. 3, the ratchet gear 108 may include a shaft 116 and a collar 118, and the cam 68 engages the ratchet surface 109 on the ratchet gear 108 with the ratchet surface 111 on the main drive gear 110. As such, it may be configured to contact the collar 118 and bias the ratchet gear 108 away from the main drive gear 112.

  Upon first actuation of the trigger 54, as described above, the cam 68 is rotated to the position illustrated in FIG. 8, and as a result of such rotation, a groove 120 in the cam 68 (FIGS. 4 and 5). ) May be configured to release the ratchet gear 108. More specifically, referring to FIGS. 5-7, the groove 120 is configured such that when rotation of the cam 68 aligns the groove 120 with the collar 118, the collar 118 can slide past the cam 68 and the ratchet spring 122. May be sized to urge ratchet gear 108 to operably engage main drive gear 110. Thereafter, trigger 54 can be released and then returned to its starting position by trigger spring 124, which can be connected to pin 126 extending from housing 90 and pin 128 extending from trigger 54. In particular, even if the trigger 54 can be returned to its starting position, the cam 68 can remain locked in the second position by the lock 92 as described above, so that the position between the groove 120 and the collar 118 is Keep the alignment. Here, ratchet gear 108 is operatively engaged with drive gear 110 and a second actuation of trigger 54 may advance cutting member 96 and staple drive within end effector 58.

  Referring primarily to FIGS. 3 and 4, actuation of trigger 54 may rotate trigger gear portion 100 about an axis defined by pin 70. The trigger gear portion 100 extends along the outer periphery of the trigger gear portion 100 and can include, for example, gear teeth that can be engaged with gear teeth extending near the circumference of the ratchet gear 108 with reference to FIGS. . During use, as a result, actuation or rotation of trigger 54 may cause ratchet gear 108 to rotate about an axis defined by shaft 116 and pin 117 (FIG. 3). As described above, with reference to FIGS. 5 and 6, the ratchet gear 108 may include a ratchet surface 109 that may be configured to engage the ratchet surface 111 of the main drive gear 110. In at least one embodiment, the ratchet surfaces 109 and 111 transmit the rotational movement of the trigger 54 to the main drive gear 110 during the second actuation of the trigger 54 or other subsequent actuation, and the trigger 54 is released, It may be configured to allow relative sliding movement between them when returned to an unactuated position. In practice, the ratchet surfaces 109 and 111 transmit rotational motion to the main drive gear 110 when the ratchet gear 108 is rotated in one direction, but the main drive when the ratchet gear 108 is rotated in the opposite direction. The gear 110 may be configured not to transmit rotational motion. Although a ratchet mechanism is described and illustrated herein, any other suitable mechanism for transmitting motion between the trigger 54 and the main drive gear 110 may be used. Further, although trigger 54 is described and illustrated as a lever, any other suitable device may be used to motivate the firing and closing drive described herein.

  Referring primarily to FIGS. 5-7, the main drive gear 110 extends near the circumference of the main drive gear 110, for example, is engaged with gear teeth of, for example, a bevel drive gear 112 that extends around the periphery. Can include gear teeth to obtain. During use, as a result, for example, rotational motion transmitted from the ratchet gear 108 to the main drive gear 110 can be transmitted to the bevel drive gear 112. In various embodiments, the bevel drive gear 112 can be attached to the shaft 113 or molded integrally with the shaft 113, and the shaft 113 can define an axis around which the bevel drive gear 112 can be rotated. In at least one embodiment, referring to FIG. 3, the surgical instrument 50 can further include a bracket 115 around which the bevel drive gear 112 and shaft 113 can be rotated. As described in greater detail below, the bracket 115 may also include a support 119 that may be configured to slidably support at least a portion of the gear platform 130. In various embodiments, referring to FIGS. 5-7, the bevel gear 114 can be attached to the bevel drive gear 112, or alternatively, the bevel gear 114 can be attached to or integral with the shaft 113. Can be molded. In either case, the rotational motion transmitted to the bevel drive gear 112 can be transmitted to the bevel gear 114.

  In various embodiments, although not illustrated, the bevel gear 114 could be directly engaged with the drive shaft 106 via cooperating bevel gear teeth. In at least one such embodiment, the bevel gear 114 could rotate the drive shaft 106, for example, clockwise to advance the cutting member 96 within the end effector 58, as described below. In such embodiments, actuation of the trigger 54 could advance the cutting member 96 within the end effector 58, but the cutting member 96 would have to be retracted manually or by an additional retraction system. Let's go. In the illustrated embodiment of the present invention and with reference to FIGS. 3 and 5-7, the surgical instrument 50 may allow the drive shaft 106 to be rotated clockwise or counterclockwise as well as a cutting member. A switching mechanism may further be included that may allow 96 to be advanced or retracted by actuation of trigger 54. In various embodiments, referring primarily to FIGS. 5 and 6, the switching mechanism may include, for example, a first position where the rotational motion of the bevel gear 114 rotates the drive shaft 106 clockwise and the rotational motion of the bevel gear 114 is driven shaft 106. A gear stage 130 can be included that can be shifted between a second position that rotates the counterclockwise.

  In various embodiments, referring to FIGS. 5-7, the gear carriage 130 includes a housing 132, a forward gear 134, and a reverse gear 136 in which the forward gear 134 and the reverse gear 136 can be rotatably mounted on the housing 132. Can be included. In at least one embodiment, the drive shaft 106 is received at an opening (not shown) in the gear 134 and gear 136 such that, for example, the forward gear 134 and the reverse gear 136 are rotatably engaged with the drive shaft 106. It can include a generally hexagonal end 107 that can be provided. In various other embodiments, end 107 may include any other suitable shape or configuration such that gears 134 and 136 are rotatably engaged with drive shaft 106. In either case, referring to FIG. 5, the gear carriage 130 can be slid along the end 107 so that the forward gear 134 or the reverse gear 136 can be engaged with the bevel gear 114. In use, for example, when the forward gear 134 is engaged with the bevel gear 114, the rotational movement of the bevel gear 114 is transmitted to the forward gear 134 and the cooperating geometry of the end 107 and the opening in the forward gear 134. Therefore, the rotational movement of the gear 134 can be transmitted to the drive shaft 106. In order to rotate the drive shaft in the opposite direction, the gear platform 130 can be slid proximally or rearward such that the reverse gear 136 engages the bevel gear 114. A mechanism for motivating the gear platform 130 in this manner is further described below.

  In various embodiments, when the forward gear 134 is engaged with the bevel gear 114 as illustrated in FIG. 5, the reverse gear 136 is engaged from the bevel gear 114 so that the reverse gear 136 rotates freely with the drive shaft 106. Can be removed. In at least one embodiment, the gear platform 130 can further include a spacer 135 that can be configured to rotatably support and align the gears 134 and 136 while the gears 134 and 136 can rotate independently of each other. In some embodiments, the gear platform 130 can be placed in an intermediate position between the forward and rearward positions, so that both gears 134 and 136 engage the bevel gear 114 so that the trigger 54 cannot be actuated. Then, the drive shaft 106 is held in the “lockout” state. In various other embodiments, the gear platform 130 can be located in an intermediate position so that neither the gear 134 nor 136 engage the bevel gear 114. In such an embodiment, the firing drive is in a “free” state and the rotational motion of the bevel gear 114 is not transmitted to the drive shaft 106.

  In various embodiments, primarily referring to FIG. 2, the drive shaft 106 can further include a threaded drive portion 138 that can be operatively engaged with the firing nut 140. In at least one embodiment, the threaded drive portion 138 can be configured to slidably advance and / or retract the firing nut 140 in response to the rotational movement of the drive shaft 106. More specifically, firing nut 140 may be configured to receive threaded drive portion 138 by screwing such that rotation of drive shaft 106 generates a reactive force that advances firing nut 140 distally. It may include a blunt opening 141. In at least one embodiment, the firing nut 140 extends from the firing nut 140 and includes a proximal channel portion half 77 and a proximal channel portion half 79 to limit movement of the firing nut 140 along the axis. A protrusion 142 may be included that may be configured to extend through a slot defined therebetween. In practice, the slot may prevent the firing nut 140 from rotating with the drive shaft 106 and may define a path for the protrusion 142 when the firing nut 140 is translated within the channel portion 78.

  In various embodiments, referring to FIG. 2, the cutting member 96 operates with the firing nut 140 such that translation of the firing nut 140 can result in translation of the cutting member 96 within the end effector 58 as described above. It can be engaged. In at least one embodiment, surgical instrument 50 is configured to connect firing bar 144 connected to firing nut 140, drive bar 146 connected to cutting member 96, and drive bar 146 to firing bar 144. And an adapter 148. In various embodiments, the firing rod 144 can include a proximal end 145 that includes an opening configured to receive at least a portion of the firing nut 140 in a press-fit manner. In at least one embodiment, the proximal end 145 of the firing rod 144 engages the recess 143 in the firing nut 140 after the deformable member 147 is pushed inward or deformed toward the recess 143. A deformable member 147 may be included that may be configured to. In either case, firing rod 144 may further include a distal end 149 that may be configured to receive plug 150, for example, in a press-fit manner, with plug 150 extending from plug 150 and slot 154 of adapter 148. A protrusion 152 may be included that may be received therein. In various embodiments, the adapter 148 can further include a slot 151 that can be translated within the distal retainer section 80 when the adapter 148 is translated by the firing rod 144. Can be configured to receive the connector clasp 154 of the drive bar 146. In at least one embodiment, the drive bar 146 engages the recess 97 in the cutting member 96 and has a distal end 156 that can be configured to advance and / or retract the cutting member 96 in the end effector 58. It may further include. As described above, the cutting member 96 includes a knife 99 that can be configured to incise tissue positioned between the anvil 62 and the staple cartridge 66 as the cutting member 96 is advanced within the end effector 58. obtain. Further, as described above, the cutting member 96 may include a portion 95 that pushes a staple drive (not shown) within the staple cartridge 66 and is removably stored in a staple (not shown). ).

  In various embodiments, the surgical instrument may provide a second overall activation of the trigger 54 in a single activation of the trigger 54, i.e., an embodiment in which the first activation of the trigger 54 closes the anvil 62 as described above. In operation, it can be configured to advance the cutting member 96 by a desired distance. However, in other embodiments, multiple actuations of the trigger 54 can be used to advance the cutting member 96 by a desired distance. In at least one such embodiment, referring to FIGS. 12-16, trigger 54 may be actuated three times to advance cutting member 96 from proximal end 59 of end effector 58 to distal end 61. However, the amount of such actuation in other embodiments will depend largely on the overall distance that the cutting member 96 is displaced and the displacement of the cutting member 96 as a result of each actuation. In particular, prior to the second actuation of the trigger 54, the cutting member 96 can be positioned at the proximal end 59 of the end effector 58 and the firing nut 140 can be positioned in the most proximal position. With reference to FIGS. 13 and 14, upon a second actuation of the trigger 54, the cutting member 96 may be advanced by approximately one third of the distance between the proximal end 59 and the distal end 61; Firing nut 140 may be advanced distally along drive shaft 106. Referring to FIG. 15, the cutting member can then be advanced by an additional third of the distance between the proximal end 59 and the distal end 61 upon a third actuation of the trigger 54, and similarly FIG. , The cutting member 96 may be advanced into the distal end 61 of the end effector 58 upon the fourth actuation of the trigger 54.

  In various embodiments, to assist the surgeon in monitoring the total number of times that the trigger 54 has been activated, the surgical instrument 50 may include the total number of times that the trigger 54 has been activated and / or within the staple cartridge. A tally mechanism may be included that may be configured to display the total remaining actuation to deploy all staples. In either case, referring primarily to FIGS. 3 and 9, one embodiment of the counting mechanism 170 includes a display nut 172, a display plate 174, and a display window 171 (FIG. 1) in the housing 90. May be included. In at least one embodiment, indicator plate 174 includes an indication above that the total number of times trigger 54 has been actuated to advance cutting member 96 can be communicated to the surgeon. In such embodiments, the indicator plate 174 may include a blank portion 173 that is visible through the window 171 before and after the first actuation of the trigger 54, ie, the actuation of the trigger 54 that closes the anvil 62 as described above. . During the second actuation of the trigger 54, the rotation of the drive shaft 106 causes the indicator nut 172 and the indicator to display so that the number “1” or other suitable indication can be seen through the indicator window 171 on the indicator plate 174. Indicator plate 174 attached to instrument nut 172 may be advanced distally. Thus, such an indication may indicate to the surgeon that the cutting member 96 has been advanced by one actuation of the trigger 54. Similar to firing nut 140, indicator nut 172 is engaged by a threaded portion 176 of drive shaft 106 and screwed so that rotation of drive shaft 106 applies a reactive force to indicator nut 172 and advances distally. Threaded openings can be included that can be mated. Subsequent actuation of the trigger 54 may move the numbers “2” and “3” below the display window 171.

  As outlined above, in order to retract the cutting member 96, the gear platform 130 can be shifted so that the forward gear 134 is disengaged from the bevel gear 114, and with reference to FIGS. Is engaged with the bevel gear 114. Thereafter, subsequent actuation of trigger 54 may cause drive shaft 106 to rotate in the opposite direction and translate firing nut 140 proximally. More specifically, due to the threaded engagement between firing nut 140 and threaded portion 138 of drive shaft 106, rotation in the opposite direction of shaft 106 displaces firing nut 140 in the proximal direction. A reactive force is applied to the firing nut 140. Thus, firing rod 144, drive bar 146, and cutting member 96 can be connected to firing nut 140 as described above and are also displaced proximally, thereby retracting cutting member 96 within end effector 58. Similarly, rotating the shaft 106 in the opposite direction may also cause the indicator nut 172 of the indicator assembly 170 to be displaced proximally. More specifically, the first actuation of the trigger 54 after the gear platform 130 is displaced, i.e., after the fifth overall actuation of the trigger 54, applies a reactive force to the indicator nut 172 on the drive shaft 106. And the nut 172 may be moved proximally. In such a situation, the indicator nut 172 is an indicator that allows the surgeon to remind the surgeon that the number “2” is required for two more actuations of the trigger 54 to fully retract the cutting member 96. The indicator plate 174 can be moved relative to the window 171 so that it is visible through the window 171.

  In this embodiment, the trigger 54 is actuated three times to advance and / or retract the cutting member 96, but the action required to advance the cutting member 96 is the cutting member in other embodiments. The actuation required to retract 96 may be different. Exemplary embodiments including features for advancing and retracting the cutting member 96 at different speeds are further described below. Further, in at least one embodiment, the portion 95 of the cutting member 96 can be engaged with the staple drive such that retraction of the cutting member 96 also retracts the staple drive. However, in other embodiments, the staple drive can be left in the staple cartridge and only the cutting member 96 is retracted. Such an embodiment would be desirable to replace a depleted staple cartridge assembly with a new staple cartridge assembly that includes its own staple drive, resulting in the used staple drive remaining in the depleted cartridge. May be used when obtaining.

  To motivate the gear platform 130 as described above, the surgical instrument 50 may include a switching mechanism 160 with reference to FIGS. In at least one embodiment, the switching mechanism 160 may include a shaft switch 162, a shift lever handle 164 extending from the shaft switch 162, and a shift lever link 166, the shift lever link 166 via a shift lever pin 169. To the shaft 162 and to the gear movable base housing 132 via the pin 168. As described above, the shift lever handle 164 has a crank arm 163 extending from the shaft 162 along the axis 105 of the drive shaft 106 to shift the gear movable base 130 with respect to the drive shaft 106. The shaft 162 may be configured to rotate so as to displace the 166 and the drive gear movable base 130. In the illustrated embodiment, when the shift lever handle 164 is disposed in a generally downward direction as illustrated in FIG. 8, the crank arm 163 is disposed in a generally upward direction. In this configuration, referring to FIG. 5, the gear platform 130 is positioned in the rearmost or proximal position such that the forward gear 134 is operatively engaged with the bevel gear 114. To shift surgical instrument 50 to a configuration in which cutting member 96 is retracted, shift lever handle 164 is rotated in an upward direction as illustrated in FIG. 17 to rotate crank arm 163 forward or distally. Let Similarly, the crank arm 163 can be configured to displace the link arm 166 distally and pull the gear platform 130 to the most distal position, thereby engaging the reverse gear 136 with the bevel gear 114. If the surgeon desires to advance the cutting member 96 after at least partially retracting the cutting member 96, the surgeon rotates the shift lever handle 164 downward to reengage the advancement gear 134 with the bevel gear 114. obtain.

  In various embodiments, referring to FIGS. 3 and 5, the surgical instrument 50 is a bi-stable fit for biasing the switching mechanism 160 into a configuration in which one of the gears 134 or 136 is engaged with the bevel gear 114. A mechanism may further be included. If described differently, a bistable adaptation mechanism may cause the switching mechanism 160 to be dynamically unstable if the surgeon rotates the shift lever handle 164 only partially. In such a situation, the bistable adaptation mechanism may bias the switching mechanism 160 into one of two configurations that are stable, ie, forward and reverse configurations. In various embodiments, the bistable adaptation mechanism 180 can include a receiver 182, a spring 184, a plunger 186, and a toggle pin 188, primarily referring to FIG. In at least one embodiment, toggle pin 188 may connect plunger 186 to switch shaft 162 and receiver 182 may be connected to a protrusion 183 extending from housing 90. In use, the spring 184 may be configured to apply a biasing force to the shaft 162 by the plunger 186, causing the shaft 162 to rotate when the shaft 162 is only partially rotated between the forward and reverse positions. Can be configured as follows.

  In various embodiments, once the cutting member 96 has been fully retracted, the end effector closure system and staple firing system can cause the depleted staple cartridge to be removed from the surgical instrument 50 and a new staple cartridge 66 can be placed in the staple cartridge channel. 64 and can be reconfigured so that the surgical instrument 50 can be used to further staple and cut tissue as described above. In the illustrated embodiment, the cam 68 can be released from the lock 92 to open the anvil 62 and reset the end effector closure system. Similarly, the ratchet gear 108 can be disengaged from the main drive gear 110 and the trigger 54 can be disengaged from the gear train 102 to reset the staple firing system. In at least one embodiment, the cam 68 and ratchet gear 108 can be manually reset, but with reference primarily to FIGS. 3-5, 9, 10, 19, and 20, the surgical instrument 50 includes the end effector described above. A resetting system that can automatically reset the closure system and the staple firing system can be included. In various embodiments, the final feedback operation of the trigger 54 may reset these systems as described in detail below.

  As outlined above, the first actuation of the trigger 54 may cause the cam 68 to rotate to the position illustrated in FIG. 8, and the spring lock 92 is actuated by subsequent actuation of the trigger 54. When configured, the cam 68 may be configured to hold in place. Also, as illustrated in FIG. 8, the surgical instrument 50 may be configured to bias the cam 68 downward, and referring to FIGS. 9 and 10, the cam lock arm 73 extending from the cam 68 is spring loaded. A cam spring 67 that holds against the lock 92 may further be included. In such embodiments, the cam lock arm 73 can include a recess 74 that can be configured to receive at least a portion of the spring lock 92. The indicator nut 174 contacts the cam rail 75 to prevent the cam 68 from rising upward during subsequent actuation of the trigger 54 and to assist the cam spring 67 when disengaged from the cam spring 92. The cam lock arm 73 may be configured to hold against the spring lock 92. More specifically, when indicator nut 174 is advanced distally as described above, indicator nut 174 can be slid along contact rail 75 and cam 68 cannot rotate relative thereto. Provide a temporary stop. Once the indicator nut 174 is returned to the most proximal position, the indicator nut 174 may be aligned with the ramp 89 so that the third feedback action of the trigger 54 causes the cam 68 to rotate slightly upward. , Thereby disengaging the lock arm 73 from the spring lock 92 as illustrated in FIG.

  After the cam 68 is released from the lock 92, the cam return spring 67 can be configured to rotate the cam 68 downward to return it to its original position. When the cam 68 is rotated downward, the wall of the cam slot 69 drives the closure link 72 distally, as well as the channel portions 78 and 80 and the staple cartridge channel 64 configured to drive distally. Can be done. In at least one embodiment, the end effector 58 is configured to bias the anvil 62 upward when the staple cartridge channel 64 is slid distally, ie, away from the outer sheath 57 of the elongate shaft assembly 56. May further include a spring (not shown). In various other embodiments, although not illustrated, the surgical instrument 50 can further include an actuator that can be operated by the surgeon to pull or push the anvil 62 into the open position. In either case, in at least one embodiment, the cam return spring 67 can exert sufficient force to disengage the ratchet gear 108 from the main drive gear 110 and, as a result, the cam drive spring 67. Set the part again. In various other embodiments, the cam return spring 67 may not be strong enough to pull the cam 68 downward with sufficient force to disengage the ratchet gear 108 from the main drive gear 110. In at least one such embodiment, surgical instrument 50 can further include a toggle switch assembly that can selectively bias ratchet gear 108 away from main drive gear 110 with reference to FIGS. 3-5 and 19. .

  In various embodiments, referring primarily to FIGS. 3, 4 and 9, toggle switch assembly 190 can include a toggle actuator 192 that is attached to drive shaft 106, and toggle actuator 192 extends from toggle actuator 192. An existing toggle arm 193 may be included. Upon final feedback actuation of the trigger 54, in at least one embodiment, the indicator nut 172 contacts the toggle actuator 192 and rotates about the drive shaft 106 so that the toggle arm 193 rotates toward the ratchet gear 108. obtain. In at least one such embodiment, referring to FIG. 9, the indicator nut 172 engages a protrusion 191 extending from the toggle actuator 192 and causes the toggle actuator 192 to rotate clockwise around the drive shaft 106. A lamp 179 that may be configured to rotate further may be included. In various embodiments, the toggle arm 193 can be configured to contact the ratchet gear 108 and displace the ratchet gear 108 away from the main drive gear 110 when rotated about the drive shaft 106. In at least one embodiment, the ratchet gear 108 can be displaced sufficiently away from the drive gear 110 to allow the cam return spring 67 to position the cam 68 adjacent the collar 118. Thereafter, the cam 68 may hold the ratchet gear 108 in this position until the cam 68 is rotated upward as described above.

  Although the mechanism described above can reset the cam 68 and ratchet gear 108 to their initial positions, at least the toggle arm 193 of the toggle actuator 192 in the illustrated embodiment remains positioned relative to the collar 118 of the ratchet gear 108. It can be up to. Thus, even if the cam 68 is rotated upward so that the groove 120 is aligned with the collar 118 during the first actuation of the trigger 54, the ratchet gear 108 engages the main drive gear 110 as described above. May not be released. With this in mind, in at least one embodiment, surgical instrument 50 may include a resetting mechanism for disengaging from ratchet gear 108 and rotating toggle arm 193. Such a mechanism may be operated manually in various embodiments, for example, and / or automatically in response to actuation of the trigger 54. In at least one embodiment, as illustrated in FIG. 20, the housing 90 extends from the housing 90 and rotates the toggle actuator 192 around the drive shaft 106 to restore the original as illustrated in FIG. A protrusion 91 may be included that may be configured to return to a non-actuated position. More specifically, in various embodiments, the protrusion 91 is configured so that the gear movable base 130 is close to the position where the forward gear 134 is engaged with the bevel gear 114 from the distal position where the reverse gear 136 is engaged with the bevel gear 114. When moved to the position, it may be configured to engage toggle link 194 (FIG. 3). Such movement can be accomplished by the switching mechanism 160 when the shift lever handle 164 moves the gear platform 130 proximally and is rotated downward to place the surgical instrument 50 in the “advance” configuration described above. . As a result of contact between toggle link 194 and protrusion 91, toggle link 194 causes toggle link 194 to contact actuator arm 193 and rotate toggle actuator 192 counterclockwise around drive shaft 106. Can be rotated around the pin 195. In various embodiments, the toggle switch assembly 190 can further include a bistable adaptation mechanism 196 that can assist in ensuring that the toggle switch assembly 190 does not move in an intermediate configuration.

  As described above, a surgical instrument according to the present invention may include a single trigger for actuating both the end effector closure system and the staple firing system. While the above features have been described in conjunction with such a single trigger surgical instrument, some of the above features operate a first trigger for actuating an end effector closure system and a staple firing system. It can be used in a surgical instrument having a second trigger for causing. For example, referring to FIGS. 23-30, surgical instrument 200 may include a trigger 201 for actuating an end effector closure system and a trigger 204 for actuating a staple firing system. In various embodiments, referring to FIG. 25, the end effector closure system may include a closure link 203 that is operatively engaged with a closure trigger 201 by a pin 209. The end effector closure system can further include a slide 205 and a closure tube 207 (FIG. 23), which can be operably connected to the closure link 203 by the slide 205 and the pin 211. More specifically, referring to FIG. 29, the closure tube 207 may be configured to be received within the slot 215 of the slide body 205 such that the sliding movement of the slide body 205 is transmitted to the closure tube 207. The most proximal flange 213 may be included.

  Referring primarily to FIGS. 29 and 30, in use, actuation of the trigger 201 may translate the closure link 203 distally, as well as the slide 205 and closure tube 207 distally. In various embodiments, the closure tube 207 includes a feature that is cooperatively engaged with the anvil 62 such that translation of the closure tube 207 rotates the anvil 62 toward the staple cartridge channel 64. More specifically, referring to FIG. 24, the anvil 62 extends from the anvil 62, the side wall of the opening 217 is adjacent to the protrusion 51, and the closure tube 207 can be rotated so that the anvil 62 can be rotated downward. A protrusion 51 that can be received in the opening 217 can be included. To guide the anvil 62, as outlined above, the staple cartridge channel 64 can include a slot 65 that can define a path for the anvil 62 when rotated. Surgical instrument 200 may further be configured to hold trigger 201 in an actuated position, thereby further including a lock 219 that holds anvil 62 in a closed position. To open the anvil 62, the lock 219 (FIG. 28) can be disengaged from the trigger 201 so that the trigger 201 can be returned to a non-actuated position. When the trigger 201 is returned to a non-actuated position, the trigger 201 drives the sliding body 205 and the closure tube 207 proximally and for operable engagement between the protrusion 51 and the opening 217. In addition, the anvil 62 can be rotated upward.

  As indicated above, a surgical instrument according to the present invention may include a firing drive that may be configured, for example, to advance the cutting member at a first speed and retract the cutting member at a different speed. In various embodiments, referring to FIGS. 23-30, a surgical instrument 200 can include a trigger 204, a drive shaft 206, a first ratchet assembly 210, and a second ratchet assembly 212. 202 may be included. In at least one embodiment, the ratchet assemblies 210 and 212 may be configured to rotate the drive shaft 206 in a clockwise and counterclockwise direction, respectively, to advance or retract the cutting member 96 within the end effector 58. In various embodiments, referring to FIG. 25, the trigger 204 may be coupled to the ratchet assemblies 210 and 212 such that only one of the ratchet assemblies 210 and 212 is driven by the trigger 204 when the trigger 204 is activated. It may be selectively engageable. In at least one such embodiment, the trigger 204 may be slidable along the pin 214 to engage the trigger 204 with one of the ratchet assemblies 210 and 212. In the illustrated embodiment, the pin 214 may be rotatably received within the opening 216 in the housing portion 218 and provide a rotational axis for the trigger 204.

  In various embodiments, referring to FIG. 27, the trigger 204 is engaged with a ratchet wheel 222 that can be pivotally mounted to the trigger 204, and when the trigger 204 is actuated, the ratchet wheel 222 is pawl 220. Can be positioned to be rotated about the pin 214. When the trigger 204 is released, the pawl 220 can slide on the ratchet teeth 224 of the ratchet wheel 222, allowing relative movement therebetween. In at least one embodiment, the ratchet assembly 210 is configured to urge the pawl 220 to engage the ratchet tooth 224 and re-engage the pawl 220 with the ratchet tooth 224 when the trigger 204 is reactivated. A pawl spring (not illustrated). To transmit the rotation of the ratchet wheel 222 to the drive shaft 206, the drive shaft 206 can include an advance gear 226 that is connected to the drive shaft 206. More specifically, in at least one embodiment, ratchet wheel 222 is operable with forward gear 226 such that rotation of ratchet wheel 222 rotates forward gear 226 and drive shaft 206 about axis 230 (FIG. 25). The gear teeth 228 may further be included that can be engaged with the gear teeth. In various embodiments, the advance gear 226 can be press fit onto the drive shaft 206, for example, or in other various embodiments, the advance gear 226 can be integrally formed with the drive shaft 206.

  In various embodiments, similar to the surgical instrument described above, the drive shaft 206 is operable with the firing nut 140 to translate the firing nut 140 within the proximal retainer portion 232, referring to FIG. Can be engaged. Also, as described above, the translation of the firing nut 140 can be transmitted to the cutting member 96 by the drive bar 146 to advance the cutting member 96 within the end effector 58. To retract the cutting member 96 within the end effector 58, in at least one embodiment, the trigger 204 is slid so that when the trigger 204 is actuated, the drive shaft 206 is rotated in the opposite direction. Two ratchet assemblies 212 may be engaged. Referring to FIG. 28, similar to the ratchet assembly 210, the ratchet assembly 212 may include a ratchet wheel 234 and pawl 236, which pawl 236 may be pivotally attached to the trigger 204, and the ratchet teeth 238 operate with the ratchet wheel 234. It can be engaged. Similar to the ratchet wheel 222, the ratchet wheel 234 can include gear teeth 240 that can be operatively engaged with a reverse gear 242 mounted to the drive shaft 206. When the ratchet wheels 222 and 234 engage the generally opposite drive shaft 206, the ratchet wheels 222 and 234 can rotate the drive shaft 206 in opposite directions, ie, clockwise and counterclockwise, respectively. Accordingly, trigger 204 is slid and operatively engaged with first ratchet assembly 210 or second ratchet assembly 212 to select whether cutting member 96 is advanced or retracted within end effector 58. Can do.

  In various embodiments, although not illustrated, the first ratchet wheel 222 and the second ratchet wheel 234 can have approximately the same diameter or pitch radius. If stated differently, the distance between the center or axis of rotation of the ratchet wheel and the gear teeth of the ratchet wheel may be the same. In such embodiments, the distance that the cutting member 96 is advanced with each actuation of the trigger 204 will be approximately the same as the distance that the cutting member 96 is retracted with each actuation of the trigger 204. While preferred in some situations, such embodiments may require the surgeon to activate the trigger 204 several times before the cutting member 96 is fully retracted. In view of the above, in various embodiments, the first ratchet wheel 222 may have a pitch radius that is different from the pitch radius of the second ratchet wheel 234. In at least one embodiment, the second ratchet wheel 234 is such that the cutting member 96 is retracted a distance for each actuation of the trigger 204 that is greater than the distance that the cutting member 96 is advanced for each actuation of the trigger 204. May have a larger pitch radius than the first ratchet wheel 222. If described otherwise, the second ratchet assembly 212 retracts the cutting member 96 at a faster rate than it is advanced, at least in these embodiments. In such an embodiment, the first ratchet assembly 210 may provide greater torque or advance force to the cutting member 96 for slower advancement speed, while the second ratchet assembly 212 may provide faster retraction. Because of the speed, the number of times the surgeon requests to retract the cutting member may be reduced.

  Although the term “speed” used above is used to describe the distance that the cutting member 96 can be advanced or retracted with each actuation of the trigger 204, the term “speed” is not so limited. In at least one embodiment, the term “velocity” may be used to describe the speed and / or acceleration at which the cutting member is moved. In such embodiments, at a higher speed and / or acceleration that is advanced at a lower speed and / or acceleration to better control the cutting member and reduce the number of times required to retract the cutting member. It may be desirable to have a cutting member that is retracted. Further, although the illustrated embodiment includes a ratchet assembly for providing different forward and reverse speeds, the present invention is not so limited. In contrast, other embodiments are envisioned that include spur gear trains, bevel gears, and / or other motion transmission devices.

  In various embodiments, a surgical instrument according to the present invention may include a gearbox for increasing or decreasing the rotational speed of the drive shaft. In at least one embodiment, referring to FIG. 25, the surgical instrument 200 can further include a drive shaft 206 and a gear box 250 that can be operatively positioned intermediate the ratchet assemblies 210 and 212. In various embodiments, the gear box 250 can be used to “gear down” the speed of the drive shaft 206 so that the shaft 206 rotates at a lower speed when the gear box 250 is not in use. In an alternative embodiment, the gearbox may be used to “gear up” the speed of the drive shaft 206 so that the drive shaft 206 rotates at a faster speed. In at least one embodiment, the gear box 250 may include at least one set of planetary gears for changing the speed of the drive shaft 206. In various other embodiments, a gear box such as the gear box 252 illustrated in FIGS. 21 and 22 is mounted on the housing 253, the input gear 254 mounted on the input shaft 256, the pinion gear 258, and the output shaft 262. Output gear 260 may be included. In such embodiments, due to the different pitch radii of input gear 254 and output gear 260, input shaft 256 and output shaft 262 will rotate at different speeds. To facilitate rotational movement of gears 254, 258, and 260 within housing 253, gear box 252 may further include various support plates 264, spacers 266, and pins 268, as illustrated in FIG. In addition to the above, the gearbox 252 can also be used to convert the clockwise movement of the input shaft 256 to, for example, the counterclockwise movement of the output shaft 262.

  In the various embodiments described above, the trigger 204 of the surgical instrument 200 is operably engaged with the first ratchet assembly 210 and the second position and the second ratchet assembly 212. It can be slid between the second position. In at least one embodiment, firing drive 202 may be disengaged from first ratchet wheel 222, for example, before first pawl 220 is engaged with second ratchet wheel 234. Can be configured. In such an embodiment, the trigger 204 may be positioned in an intermediate position that is not operatively engaged with the first ratchet assembly 210 or the second ratchet assembly 212. In various embodiments, as a result, firing drive 202 may be in a “free” state in which actuation of trigger 204 does not result in rotation of drive shaft 206. In an alternative embodiment, the firing drive 202 may engage the second ratchet wheel 234, for example, before the second pawl 236 is operatively disengaged from the first ratchet wheel 222. Can be configured to be combined. In such an embodiment, the trigger 204 may not be actuated so that the trigger 204 is not fully engaged with any one of the ratchet assemblies and the trigger 204 requires further adjustment. May be positioned in an intermediate “locked” state, indicating to the surgeon.

  In various embodiments, the surgical instrument 200 can include a device that biases the trigger 204 to engage one of the first ratchet assembly 210 and the second ratchet assembly 212. In at least one embodiment, referring to FIG. 33, the surgical instrument 200 can engage the first ratchet assembly 210 or the second ratchet assembly 212 by biasing the trigger 204 from the intermediate position described above. A stable fitting mechanism 270 may further be included. In various embodiments, the bistable adaptation mechanism 270 can include a spring 272 and a link 274 that act to cause the biasing force to move the trigger 204 from an intermediate position illustrated in FIG. A biasing force may be applied to the trigger 204 by the link 274 to engage the first ratchet wheel 222 or the second ratchet wheel 234. More specifically, when trigger 204 is positioned in an intermediate position, spring 272 can be stretched to length X1, and due to the elasticity of spring 272, spring 272 can be unstretched or at least, eg, length It may be attempted to shorten to a length shorter than X1, such as X2. Spring 272 can rotate link 274 about pin 275 so that spring 272 itself shortens to length X2, from which pin 275 extends and pivots link 274 to surgical instrument housing 218. Can be installed as possible. More specifically, when the first end of spring 272 is attached to pin 276 extending from housing 218 and the second end of spring 272 is attached to pin 277 extending from link 274. The spring 272 is shortened by moving the pin 277 closer to the pin 276, which is most easily accomplished by rotating the link 274 about the pin 275. As the link 274 is rotated about the pin 275, the side wall of the slot 278 in the link 274 engages the pin 279 extending from the trigger 204 and the trigger 204 is slid to cause the first ratchet wheel 222 or Two ratchet wheels 234 may be configured to engage. In practice, the intermediate position of the trigger 204 illustrated in FIG. 33 represents a dynamically unstable position, and the position of the trigger 204 where the trigger 204 is engaged with the ratchet wheels 222 and 234 is the movement of the firing drive system. Represents a stable position.

  In various embodiments, as described above, a surgical instrument in accordance with the present invention includes, for example, a first direction in which the drive shaft advances the cutting member within the end effector and a second direction in which the drive shaft retracts the cutting member. May include a device for rotating the drive shaft. In at least one embodiment, referring to FIGS. 31 and 32, a surgical instrument can include a transmission 280 that can, for example, allow a surgeon to select whether the drive shaft advances or retracts the cutting member. . In various embodiments, the transmission 280 can include a housing 282, an internal input shaft 284, an external input shaft 285, an output drive shaft 286, and a switching mechanism 288 that includes the internal input shaft 284 and the external Input shaft 285 may be configured to selectively engage output shaft 286. Although not illustrated, the surgical instrument may further include, for example, a trigger operatively engaged with the external drive shaft 285, for example, to rotate the drive shaft 285 clockwise about the axis 287. In at least one embodiment, the transmission 280 includes a pinion gear 292 that is rotatably mounted in the housing 282, an input gear 293 that is fixedly mounted on the external input shaft 285, and an output gear that is mounted on the output drive shaft 286. 294 and the input gear 293 may be operatively engaged with the outer gear teeth 290 of the pinion gear 292 such that rotation of the external shaft 285 is transmitted to the pinion gear 292.

  In the first configuration of the transmission 280, the output gear 294 can be operatively engaged with the inner gear teeth 291 of the pinion gear 292 such that rotation of the pinion gear 292 is transmitted to the output drive shaft 286. More specifically, the output gear 294 can be operatively engaged with the output drive shaft 286 by an end 296 that is splined such that the output gear 294 drives the output drive shaft 286 about the shaft 287. In this first configuration, for example, clockwise rotation of the external input shaft 285 can be converted to counterclockwise movement of the output drive shaft 286. In the second configuration of the transmission 280, the output gear 294 can be disengaged from the pinion gear 292 so that the rotation of the external input shaft 285 is not transmitted to the output drive shaft 286 via the pinion gear 292. In order to disengage the output gear 294 from the pinion gear 292, the internal drive shaft 284 has an external drive shaft 285 so that the input gear 297 contacts the recess 298 at the output gear 294 and pushes the output gear 294 away from the pinion gear 292. Can be slid against. In at least one embodiment, the recess 298 can include teeth 299 that can be operatively engaged with the input gear 297 of the internal input shaft 284 such that rotation of the internal input shaft 284 is transmitted to the output drive shaft 286. In this second configuration of transmission 280, the clockwise rotation of internal input shaft 284 can be transmitted directly to output drive shaft 286 such that output shaft 286 also rotates clockwise. In order to re-engage the output gear 294 with the pinion gear 292, the internal input gear 284 is removed from the output gear 294 to allow the spring 281 to slide along the splined end 296. Can be disengaged.

  In the above embodiment, the surgeon may selectively move the internal input shaft 284 relative to the external input shaft 285 to place the transmission 280 in an advanced or reverse configuration. To move the input shaft 284, in various embodiments, the surgical instrument may further include an actuator or trigger configured to translate the internal input shaft 284. In at least one embodiment, the surgical instrument has a first actuator or trigger for rotating the external input shaft 285 and a second actuator or trigger for translating the inner shaft 284 relative to the outer shaft 285. Can be included. In such an embodiment, the internal input shaft 284 is coupled to the external input shaft 285 so that rotation of the external shaft 285 is transmitted to the internal shaft 284, but nevertheless a sliding motion is possible between them. A spline 283 that may be slidably engaged may be included. In at least one embodiment, the transmission 280 further includes a bearing 300 that can rotatably support the input gear 293 to allow the input gear 293 to operate with the pinion gear 292 when compressed between the input gear 293 and the housing 282. A biasing force may be provided to hold the engaged state. In various embodiments, the output shaft 286 extends from the output shaft 286 and is received within the recess 301 of the housing 282 to reduce or eliminate relative movement between the output shaft 286 and the housing 282. May include a member 302 that may be configured as described. Although not illustrated in at least one embodiment, transmission 280 may have only one pinion gear 292 and still operate in the manner described above.

  In various embodiments, the transmission 280 can be configured to advance the cutting member 96 at a different speed than the retracted speed, for example. In at least one embodiment, referring to FIGS. 31 and 32, operable engagement between the internal input shaft 284 and the output shaft 286 can be used to advance the cutting member 96, and the input gear 297 and the output gear Due to the direct engagement with 294, the internal input shaft 284 and the output shaft 286 rotate at a one-to-one ratio, i.e., at a rate that causes the output shaft 286 to rotate once for every rotation of the internal input shaft 284. Can do. In various embodiments, operable engagement between the external input shaft 285 and the output shaft 286 can be used to retract the cutting member 96, different pitch radii of the input gear 293 and the output gear 294, and pinions Due to the operable engagement with 292, the external input shaft 285 and the output shaft 286 may rotate at a different ratio than 1: 1. In the illustrated embodiment, the output shaft 286 can rotate at a faster speed than the external input shaft 285 when fitted by the pinion 292. In various embodiments, as a result, the cutting member 96 is more operative when the external input shaft 285 is operatively engaged with the output shaft 286 than when the internal input shaft 284 is operatively engaged with the output shaft 286. Can be translated at high speeds.

  The above invention also has applicability to robotic surgical systems. Such systems are well known in the art and are described in Intuitive Surgical, Inc. , Available from Sunnyvale, CA. Examples are also described in US Pat. Nos. 6,783,524, 7,524,320, and 7,824,401. All references cited herein are hereby incorporated by reference.

  In general, a robotic surgical system has a remotely controllable user interface and a remotely controllable arm configured to interface with and operate the surgical instrument and system. The arms are typically controllable with electronic control system (s) that are compatible with the local console to which the user interfaces. The instrument may be powered locally by the surgical system or may have a separate power supply system from full robot control.

  The robotic surgical system includes at least one surgical instrument configured to perform at least one surgical task and be removably attached to a distal end of an arm, an actuation assembly, a monitor, and a robot. And at least one mounting unit securely attached to a robot arm having

  In yet another embodiment, the robotic surgical system receives the electrical signal transmitted from the processor, at least one encoder that determines the position of the at least one power joint, and the staple unit, and controls movement. Including a receiver.

  An exemplary disposable mounting unit for use with a robot is disclosed in US Pat. No. 6,231,565 to Tovey et al. An exemplary surgical robot with proportional surgeon control is disclosed in US Pat. No. 5,624,398 to Smith et al.

  In another aspect of the invention, a robotic system includes a frame and a robot arm having a stapling assembly with an elongated tube that is movable relative to the frame and connects the stapling assembly to the robot arm. . Both the elongated tube with the stapling assembly and the stapling assembly itself are removably attached and operably coupled to the robot arm. One configuration of the stapling assembly can be removed and a different configuration can be attached and operated.

  About FIGS. The robotic system detachably attaches to the proximal end of the closure tube 207 and includes a connecting member that radially connects to the proximal end of the drive shaft 206.

  The devices disclosed herein can be designed to be disposed of after a single use, or designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of equipment disassembly steps, subsequent cleaning steps or specific part replacement steps, and subsequent reassembly steps. In particular, the device can be disassembled, and any number of the particular parts or members of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular members, the device can be reassembled at a reconditioning facility or by a surgical team immediately prior to a surgical procedure and then used for subsequent use. One skilled in the art will recognize that various techniques for disassembly, cleaning / replacement, and reassembly can be used to recondition the device. The use of such techniques, and the resulting reconditioned device, are all within the scope of this application.

  Preferably, the invention described herein is processed before surgery. First, a new or used instrument is obtained and cleaned as necessary. The instrument can then be sterilized. In one sterilization method, the instrument is placed in a closed and sealed container such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high energy electron beams. This radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

  While the present invention has been described as having an exemplary configuration, the present invention can be further modified within the spirit and scope of the present disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Furthermore, this application is intended to cover developments from the present disclosure as known in the art to which this invention pertains or which are included in conventional practice.

Embodiment
(1) a surgical instrument,
A remotely controllable user interface;
A firing drive configured to generate a rotational firing motion during a first actuation of the remote controllable user interface and a rotational retracting motion during another actuation of the remote controllable user interface;
A first drive member with which the remotely controllable user interface is selectively engageable;
A firing drive comprising: a second drive member to which the remotely controllable user interface is selectively engageable;
An elongate shaft assembly operatively engaged with the first drive member and the second drive member;
An end effector coupled to the elongate shaft assembly,
An elongate channel configured to operably support a staple cartridge therein;
An anvil movably coupled to the elongated channel;
A cutting member operably supported in the elongate channel, wherein the cutting member is operatively engaged with the elongate shaft assembly and the remotely controllable user interface operates the first drive member. When the first operation advances the cutting member by a first distance and the remote controllable user interface operates the second drive member, the other operation causes the cutting member to move first. A surgical instrument comprising: an end effector comprising a cutting member retracted by a distance of 2 and wherein the second distance is greater than the first distance.

Claims (1)

A surgical instrument,
A remotely controllable user interface;
A firing drive configured to generate a rotational firing motion during a first actuation of the remote controllable user interface and a rotational retracting motion during another actuation of the remote controllable user interface;
A first drive member with which the remotely controllable user interface is selectively engageable;
A firing drive comprising: a second drive member to which the remotely controllable user interface is selectively engageable;
An elongate shaft assembly operatively engaged with the first drive member and the second drive member;
An end effector coupled to the elongate shaft assembly,
An elongate channel configured to operably support a staple cartridge therein;
An anvil movably coupled to the elongated channel;
A cutting member operably supported in the elongate channel, wherein the cutting member is operatively engaged with the elongate shaft assembly and the remotely controllable user interface operates the first drive member. When the first operation advances the cutting member by a first distance and the remote controllable user interface operates the second drive member, the other operation causes the cutting member to move first. A surgical instrument comprising: an end effector comprising a cutting member retracted by a distance of 2 and wherein the second distance is greater than the first distance.

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